Device for tissue suturing



April 1966 A. l. BOORLAKOV ET AL 3,244,342

DEVICE FOR TISSUE SUTURING Filed May 21, 1963 4 Sheets-Sheet 1 April 1966 A. l. BOORLAKOV ET AL 3,244,342

DEVICE FOR TISSUE SUTURING 4 Sheets-Sheet 2 Filed May 21, 1965 April 1966 A. BOORLAKOV ET AL 3,244,342

DEVICE FOR TISSUE SUTURING 4 Sheets-Sheet 5 Filed May 21, 1963 FIG. 5

FIG. 14

April 1966 A. l. BOORLAKOV ET AL 3,244,342

DEVICE FOR TISSUE SUTURING Filed May 21, 1963 4 Sheets-$heet 4 FIG/0 United States Patent ice 3,244,342 DEVICE FOR TISSUE SUTURING Alexandr Ivanovich Eoorlalrov, Alexey Nickolaevich Ljuhimov, Alexandr Ivanovich Axenov, Yzigori Nickolaevicli Zoobakov, Victor Nickolaevich Goodkov, Valentina Fiodorovna Zheleznova, Vladimir Fjodorovich Chelkin, Inna Anatoljevna Ginevskaja, Leonid Ivanovich Kookooshkin, and Boris Nickolaevich Goolin, all of Moscow, U.S.S.R., assiguors to Nauchno- Issledovatelsky Institute Experimentaluoi Khirurgiclieskoi Apparatury i Instrumentov Filed May 21, 1963, Ser. No. 282,047 2 Claims. (Cl. 227-19) This invention relates to a surgical device and more specifically to a surgical device for suturing tissue primarily for use in ophthalmology and neurosurgery.

It is known that at the present time surgical devices exist and by means of which vessels, lung hilum, bronchi, stomach and intestines, etcetera, are sutured with the aid of metallic clips.

Some of the proposed devices simultaneously place several clips, while others place the clips consecutively.

However, with such devices it is only possible to suture such tissues as vascular ones in such a fashion that the edges of the latter project above the stitch forming selvedges.

When using these instruments for suturing, both ends of the clip pierce the tissues lying in two parallel planes and the existing instruments do not permit the suturing of tissues lying in one plane without the formation of projecting selvedges. Thus, not a single one of the currently known instruments is suitable for suturing the cornea in case of injury and transplantation and for keratoplastics of the face skin at cosmetic surgical interventions. This is due to the fact that in all of these cases it is necessary that the tissue edges be exactly flush with each other and the suturing be performed with one clip located perpendicularly to the line of the lip of the wound.

At present, the suturing of the dura mater, the cornea and sclera is accomplished by a needle and thread and/ or wire. Such operations may be performed only by a highly skilled surgeon, but even in such a case complications may arise, since when trying individual stitches by knotting, the holes formed in the tissue by the puncturing enlarge, and the threads which consist of separate strands or filaments promote infiltration, etcetera. Applicants are not aware of any devices which permit a mechanical stitch to be sewn on tissues having their edges flush with one another.

An object of the present invention is to provide a device which assures joining of the tissues in end-to-end relationship and which holds such tissues in the device during the suturing of the edges with clips.

Another object of the invention is to provide means for the rapid and reliable suturing of tissues joined in endto-end relationship with the aid of metallic clips.

Still another object of the invention is to provide means for the end-to-end suturing of tissues having different edge thicknesses and lacerated selvedges.

The essence of the invention resides in that for tissues and organs to be sutured in end-to-end relationship with the aid of metallic clips, there are used a T- shaped matrix in the form of a central rod for bending the clips and clamps for fixing, either individually or simultaneously, the tissue edges on the matrix with such devices also serving for orienting the movement of the clips during the course of suturing.

Further objects and advantages of the invention will become more readily apparent to a person skilled in the 3,244,342 Patented Apr. 5, '1966 art from the following detailed description and annexed drawings, and in which drawings:

FIGURE 1 is a view in side elevation of a device for suturing the cornea and sclera.

FIGURE 2 is a vertical sectional view of the device illustrated in FIGURE 1.

FIGURE 3 is a top plan view with certain parts being in section of the device shown in FIGURE 1.

FIGURE 4 is a sectional view taken along the line 4-4 of FIGURE 2, the view looking in the direction of the arrows.

FIGURE 5 is a side view partly in section of the matrix.

FIGURE 6 is a sectional view of the matrix along the apertures where the bending of the legs of the clip occurs.

FIGURE 7 is a sectional view taken along, the line 7-7 in FIG. 2, the view looking in the direction of the arrows.

FIGURE 8 is a side elevational view of the left-hand clamp.

FIGURE 9 is a plan view of the left hand clamp.

FIGURE 10 is a fragmentary sectional view of the matrix end of the device shown in FIG. 1 and illustrating the arrangement of the clips prior to suturing.

FIGURE 11 is a sectional view taken along the line 11-11 of FIGURE 10, the view looking in the direction of the arrows.

FIGURE 12 is a sectional view taken along the line 12-12 of FIGURE 2, the view looking in the direction of the arrows.

FIGURE 13 is a side view of the suture effected by the present invention, and

FIGURE 14 is a plan view of FIGURE 13.

As shown in FIGURES 1-3, the main component of the appliance for suturing the cornea or sclera is a body 1 on which all of the other parts are mounted. At the left hand side of the body 1 is located a T-shaped matrix 2 provided with supporting lugs 3 rigidly connected with two plates 4 and the plates 4 are located in side slots or grooves formed in the body 1 as per haps best illustrated in FIGURE 4.

The ends of the plates 4 are formed with slots which receive projections '5 and 6 of a screw 7 (FIGURE 3) and an adjustment nut 8 is threaded onto the end of the screw 7 and which is disposed in a slot of the body 1 which arrests the travel of the nut along the axis thereof.

Upon rotation of the nut 8 the screw 7 together with the plates 4 and the matrix 2 moves along the axis of the body 1. On the surface of the lugs 3 facing the body 1 are depressions 9 as shown in FIGURES 5 and 6, which serve for bending the clip ends during suturing. A removable magazine 10 (FIGURE 7) is provided for the upper portion of the appliance and in a slot of the magazine are disposed staple-shaped metallic clips for the suturing operation. The ejection of the next clip in turn from the magazine 10 is achieved via a feeder 11 actuated by a spring 12, as clearly shown in FIG- URE 2. The spring '12 is rigidly connected with a plate 13, one end of which is held in the magazine 10 and the other end thereof is secured to the body 1 by lugs 14. The plate 13 is provided with a longitudinal through slot 15 which terminates in a round aperture and when pin 16 secured in the body 1 is aligned with the round hole of the slot 15, the plate 13 is separated from the body 1 thereby releasing magazine 10 and feeder 11 for the later replacing of the magazine. To replace an empty magazine With .a filled magazine, the plate 13 is moved toward the right in FIGURE 2 so that the magazine 10 and feeder 11 can be released from the body. A lid or cover 17 (FIGURE 4) is provided for the body 1 and the internal surface thereof is formed with slots .3. 18 and 19 (FIGURE 3) disposed at an angle with respect to the axis of the body 1 and clamps 2t) and 21 are respectively located in such slots.

The clamps 2!} and 21 are designed for fixing the edges of the tissue in the suturing appliance on the supporting lugs 3 of the matrix 2 and the clamps are similar in structural detail. More specifically, and attention is called to FIGURES 8 and 9 each clamp consists of two plates 23 and 24 rigidly connected to each other with a slot 25 being located between the plates and the width of the slot is equal to the diameter of the staple, preferably 0.1 mm.

With the movement of the clip towards the matrix 2 the slot 25 of the clamps 2t and 21 serves as a guide for the clip and insures a direct engagement of the ends of the clip inthe depressions 9 of the lugs 3 of the matrix 2, as illustrated in FIGURES l and 11. It will be noted that the slots of the clamps are located in a plane crossing the lugs 3 at a right angle and are in line with the depressions. The tail end of each clamp is in the form of a hook 26 and by means of which the clamps are loosely connected with slides 27 and 28 (FIGURES 1 and 3). The slides 27 and 28 enter the side grooves of the body 1 and are retained therein by means of the lugs 14, as best shown in FIGURE 12. Projections 29 and 36 serve as abutments for the fingers of the surgeon when the slides 27 and 28 are moving. The outside surface of each projection is formed with a concavity which is roughened in order that the fingers of the surgeon will not slip relative thereto.

"2); With manual rotation of the segment 36 in a counterclockwise direction, the finger 35 transmits advancing movement of the driver 31 via the rod 33 towards the .matrix 2. The return of the segment 36 to its initial position isetfected via a spring 38 disposed in a handle 39.

The operation of the device is as follows:

- Preparatory to use, the device together with the magazine and clips is sterilized and dependent upon the required height of the clips and the thickness of the tissues, the necessary clearance between the lugs 3 of the matrix 2 and the driver 31 is established. In order to suture tissues in end-to-end relationship, one of the lugs 3 of the matrix 2 is placed under the edge of the tissue to be sutured. The surgeon, by pressing with one of his fingers on the corresponding projection such as projection 29 .of the slide 28 which is loosely connected with the clamp 21 via the hook 26, moves the clamp toward the matrix 2 and fixes the tissue with the end thereof on the support lug 3.

By moving the device with one edge of the tissue fixed, the other lug 3 is positioned below or underneath 'the second edge of thetissue and is fixed in the manner above described.

The next clip ejected by the feeder 11 is always positioned in front of the driver 31 in the slot 25 of the clamps 20 and. 21, and by turning the segment 36 in a counterclockwise direction by the surgeons thumb, the driver 31 acts upon the back of the clip and moves the same in a forward direction along the slot 25. The limbs of the clip which pierce the edges of the tissue enter the depressions 9 of the lugs 3 and are bent. After suturing, the segment 36 automatically returns to its initial position due to the action of the spring 30 and simultaneously moves or carries the driver 31 therewith. Thereafter, the clamps 20 and 21 either separately or simultaneously are removed from the supporting lugs 3 of the matrix 2.

Additional clips are positioned in the same manner and the distance between the clips can be selected at will by the surgeon.

To replace the clips, the empty magazine 10 is replaced with a filled magazine and for this purpose the plate 13 is moved in the direction of the handle 39 so that the magazine 10 and feeder 11 can be removed.

The present invention assures end-to-end juxtaposition of the edges of the tissue of varying thickness and with uneven edges lying in one plane without the formation of projecting selvedges, as can be clearly seen from FIGURES 13 and 14. When this is being efiected, each edge of the tissue is pierced with only one clip end or limb disposed perpendicularly to the line of the edge.

The invention is not to be confined to any strict conformity to the showings in the drawings but changes or modifications may be made therein so long as such changes or modifications mark no material departure from the spirit and scope of the appended claims.

What we claimed is:

1. A surgical instrument for suturing tissues lying in one plane end-to-end located by means of metallic clips comprising, a body provided with an elongated assembly part and a handle, a T -shaped matrix having a middle ro-d carried by said body at the end of said assembly part, supporting lugs extending from the rod in different directions and located on a single line, and adapted to be positioned under the tissue edges to be joined during suturing, said supporting lugs having concave portions for bending the clip ends thereon on the sides facing the body, clamps mounted. in said assembly part on different .sides of said middle rod for separate independent movements towards the supporting lugs for clamping the tissue edges to said supporting lugs by means of the ends of the clamps, manual manipulatable means operably coupled to the respective clamps for independently moving the clamps toward the supporting lugs, a removable magazine adapted to contain a series of metallic clips mounted on said. body between said clamps and adapted to orient the clip ends with respect to said concave portions, guiding slots for said clips provided in said clamps in a plane crossing the supporting lugs at a right angle and in line with the concave portions, spring means coacting with said magazine for the successive feeding of the clips to the guiding slots, and a manually .operated driver mounted for travel in said guide slots for the movement of the clips from the magazine through said slots to the matrix whereby the clip ends pierce the tissue edges clamped to the supporting lugs, and by engaging the concave portions of the supporting lugs the clips are bent thus connecting the tissue edges.

2. A surgical instrument for suturing tissues lying in one plane end-to-end located by means of metallic clips comprising, a body provided with an elongated assembly part and a handle, a T-shaped matrix having a middle rod carried by said body at the end of said. assembly part, supporting lugs extending from the rod in different directions and located on a single line, and adapted to be positioned under the tissue edges'to be joined during suturing, said. supporting lugs having concave portions for bending the clip ends thereon on the sides facing the body, clamps mounted in said assembly part of the body on different sides of said middle rod for separate independent movements towards the supporting lugs for clamping the tissue edges to said supporting lugs by means of the ends of the clamps, manual'manipulatable means operably coupled. to the respective clamps for independently moving the clamps toward the supporting lugs, a removable magazine adapted to contain a series of metallic clips mounted on said body between said clamps and adapted to orient the clip ends with respect to said concave portions, guiding slots for said clips provided in said clamps in a plane crossing the supporting lugs ata right angle and in line with the concave portions, spring means coasting with said magazine for-the. successive feeding of the clips to the guiding slots, a manually op 5 erated driver mounted for travel in said guide slots for the movement of the clips from the magazine through said slots to the matrix whereby the clip ends pierce the tissue edges clamped to the supporting lugs, and by engaging the concave portions of the supporting lugs the clips are bent thus connecting the tissue edges, an adjustment screw means connecting the middle rod with the body for movement to adjust the clearance between the supporting lugs of the matrix and the driver, and a turning segment mounted in said handle and connected with 10 the driver for its movement.

References Qited by the Examiner UNITED STATES PATENTS 2,853,074 9/1958 Olson 1349 X 2,874,384 2/1959 Krone 1-349 3,079,608 3/1963 Babkin 1-349 X FOREIGN PATENTS 618,922 9/ 1935 Germany.

GRANVILLE Y. CUSTER, IR., Primary Examiner. 

1. A SURGICAL INSTRUMENT FOR SUTURING TISSUES LYING IN ONE PLATE END-TO-END LOCATED BY MEANS OF METALLIC CLIPS COMPRISING, A BODY PROVIDED WITH AN ELONGATED ASSEMBLY PART AND A HANDLE, A T-SHAPED MATRIX HAVING A MIDDLE ROD CARRIED BY SAID BODY AT THE END OF SAID ASSEMBLY PART, SUPPORTING LUGS EXTENDING FROM THE ROD IN DIFFERENT DIRECTIONS AND LOCATED ON A SINGLE LINE, AND ADAPTED TO BE POSITIONED UNDER THE TISSUE EDGES TO BE JOINED DURING SUTURING, SAID SUPPORTING LUGS HAVING CONCAVE PORTIONS FOR BENDING THE CLIP ENDS THEREON ON THE SIDES FACING THE BODY, CLAMPS MOUNTED IN SAID ASSEMBLY PART ON DIFFERENT SIDES ON SAID MIDDLE ROD FOR SEPARATE INDEPENDENT MOVEMENTS TOWARDS THE SUPPORTING LUGS FOR CLAMPING THE TISSUE EDGES TO SAID SUPPORTING LUGS BY MEANS OF THE ENDS OF THE CLAMPS, MANUAL MANIPULATABLE MEANS OPERABLY COUPLED TO THE RESPECTIVE CLAMPS FOR INDEPENDENTLY MOVING THE CLAMPS TOWARD THE SUPPORTING LUGS, A REMOVABLE MAGAZINE ADAPTED TO CONTAIN A SERIES OF METALLIC CLIPS MOUNTED ON SAID BODY BETWEEN SAID CLAMPS AND ADAPTED TO ORIENT THE CLIP ENDS WITH RESPECT TO SAID CONCAVE PORTIONS, GUIDING SLOTS FOR SAID CLIPS PROVIDED IN SAID CLAMPS IN A PLANE CROSSING THE SUPPORTING LUGS AT A RIGHT ANGLE AND IN LINE WITH THE CONCAVE PORTIONS, SPRING MEANS COACTING WITH SAID MAGAZINE FOR THE SUCCESSIVE FEEDING OF THE CLIPS TO THE GUIDING SLOTS, AND A MANUALLY OPERATED DRIVER MOUNTED FOR TRAVEL IN SAID GUIDE SLOTS FOR MOVEMENT OF THE CLIPS FROM THE MAGAZINE THROUGH SAID SLOTS TO THE MATRIX WHEREBY THE CLIP ENDS PIERCE THE TISSUE EDGES CLAMPED TO THE SUPPORTING LUGS, AND BY ENGAGING THE CONCAVE PORTIONS OF THE SUPPORTING LUGS THE CLIPS ARE BENT THUS CONNECTING THE TISSUE EDGES. 